Applying GRADE for diagnosis 33 2 Table 3. Consequences of the test results Test result Effects Patient-important outcomes True positive True AR diagnosis, leading to targeted treatment, eventually with side effects Effective treatment reduces symptoms Level of avoidance measures Possible side effects of drug treatment Treatment costs for the patient True negative True AR exclusion Possible non-AR diagnosis, or performance of additional diagnostic tests Persisting symptoms (unless non-AR is treated effectively) No allergen avoidance and side effects Additional testing and treatment risks False positive False AR diagnosis, leading to ineffective targeted treatment, eventually with side effects Persisting symptoms Potential avoidance measures Potential side effects Costs Additional testing risks False negative False AR exclusion, no targeted treatment Follow-up tests Persisting symptoms Follow-up test risks AR: allergic rhinitis Clinical results and certainty of the evidence Diagnostic test accuracy Three studies estimated the accuracy of sIgE-testing on the house dust mite D.pteronyssinus, one of which also studied D.farinae [21-23]. Sensitivity varied from 84% to 100% and specificity from 52% to 100%. Because of heterogeneity, we did not pool results. The certainty of evidence was very low due to serious risk of bias, indirectness and imprecision. Test burden We did not find evidence that fulfilled our eligibility criteria of assessing the burden of venipuncture. Clinical management Allergen avoidance measures One systematic review comprising nine RCTs was included [24]. The effect estimates of the RCTs were not pooled because of clinical heterogeneity in interventions. HEPA (high-efficiency particulate air) filters were associated with a lower symptom score than placebo but were not statistically tested. Intensive bedroom cleaning combined with acaricides (a pesticide) might be related to lower symptom scores, but no absolute results were reported. The review reported inconsistent evidence about the effectiveness of allergy control bedding.
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